Hemorrhoids, anal prolapse and fissure - surgical treatment

1. Big picture

This is a common proctology surgery topic. The examiner wants you to separate benign anorectal disease from dangerous mimics, especially colorectal cancer, inflammatory bowel disease, perianal sepsis, and anal malignancy.

The surgical logic is:

Bright red rectal bleeding / anal pain / protruding anal mass
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Inspect anus + digital rectal examination + anoscopy/proctoscopy if possible
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Identify hemorrhoids, fissure, prolapse, abscess, fistula, tumour, or IBD
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Conservative treatment first if uncomplicated
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Office procedure or surgery if high-grade, recurrent, complicated, or refractory

Core exam sentence:

Hemorrhoids cause painless bright red bleeding and prolapse; anal fissure causes severe defecation pain with bright red bleeding; rectal/anal prolapse causes circumferential protrusion and may cause mucus, bleeding, constipation, and incontinence. Surgery is chosen according to grade, symptoms, continence status, and emergency complications.

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